Rahmi Gabriel, Hotayt Bilal, Chaussade Stanislas, Lepilliez Vincent, Giovannini Marc, Coumaros Dimitri, Charachon Antoine, Cholet Franck, Laquière Arthur, Samaha Elia, Prat Frédéric, Ponchon Thierry, Bories Erwan, Robaszkiewicz Michel, Boustière Christian, Cellier Christophe
Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.
Endoscopy. 2014 Aug;46(8):670-6. doi: 10.1055/s-0034-1365810. Epub 2014 Jun 30.
Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate for superficial colorectal tumors. The aims of this study were to assess the feasibility of ESD in France and to evaluate the complete resection rate at 1 year.
Patients with superficial rectal tumors ≥ 10 mm in size were prospectively included in the study at nine French expert centers between February 2010 and June 2012. The study was stopped temporarily because of a high complication rate. Study recruitment resumed following remedial action.
A total of 45 patients were included (mean age 67 years; 24 males). The immediate perforation rate was 18 % (n = 8), and salvage surgery was not required. Six patients (13 %) had late bleeding, which was treated endoscopically in five patients and surgically in one patient who had required blood transfusion. The mortality rate was zero. The en bloc resection rate was 64 % (29/45), and the curative R0 resection rate was 53 % (24/45). Three patients (7 %) had an invasive tumor (two sm1, one T2). At 1-year follow-up, endoscopic examinations showed complete resection in 38 /43 patients (88 %). At the end of the study, after the remedial action, the en bloc resection rate had increased from 52 % to 82 %, and the perforation rate had decreased significantly from 34 % to 0 %.
The study reflects the initial prospective experience of ESD in France, and suggests that curative R0 resection rates should increase and complication rates should decrease with experience and corrective actions.
内镜黏膜下剥离术（ESD）对浅表性结直肠肿瘤具有较高的整块切除率。本研究旨在评估ESD在法国的可行性，并评估1年时的完整切除率。
2010年2月至2012年6月期间，9个法国专家中心对大小≥10mm的浅表性直肠肿瘤患者进行前瞻性纳入研究。由于并发症发生率高，研究暂时停止。采取补救措施后恢复入组。
共纳入45例患者（平均年龄67岁；男性24例）。即时穿孔率为18%（n = 8），无需挽救性手术。6例患者（13%）发生迟发性出血，5例经内镜治疗，1例输血患者接受手术治疗。死亡率为零。整块切除率为64%（29/45），根治性R0切除率为53%（24/45）。3例患者（7%）存在浸润性肿瘤（2例sm1，1例T2）。1年随访时，内镜检查显示43例患者中有38例（88%）实现完整切除。研究结束时，采取补救措施后整块切除率从52%提高到82%，穿孔率从34%显著降至0%。
本研究反映了法国ESD的初步前瞻性经验，表明随着经验积累和采取纠正措施，根治性R0切除率应会提高，并发症发生率应会降低。
